With the failure of the World Trade Organization’s (WTO) 144 member countries to reach an agreement on the compulsory licensing of essential medicines, affordable live-saving drugs for the world’s poorest countries are as far away as ever. WTO missed the December 2002 deadline after the United States blocked the proposed deal, and subsequent discussions have failed to yield a decision.

The United States wants to limit the agreement to medicines that treat HIV/AIDS, tuberculosis, and malaria, whereas the poorest countries want to determine their own public health priorities. During the round of global trade talks that began in November 2001 in Doha, Qatar, developing countries pushed for the right to make copies of patented medicines, as set out in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

Indeed, more than a year ago, as part of the Doha agreement, WTO members said developing countries should be able to override patents and license local manufacturers to make generic medicines. But no provision was made for countries without manufacturing capacity of their own – the majority – to import cheap copies from elsewhere.

Citing worries about manufacturers in Brazil and India stealing their markets, pharma companies lobbied successfully to persuade the United States to reject an agreement allowing cheap generics to be imported. More recent talks in Tokyo and Geneva failed to resolve the impasse.

Another proposal from the TRIPS council to limit the use of compulsory licensing to national emergencies or other urgent circumstances was met with alarm by developing countries, aid organizations and pressure groups. As the director of the Campaign for Access to Essential Medicines pints out, ‘In Africa, pneumonia is the second biggest killer after HIV-AIDS. Will countries declare pneumonia a national emergency? It is hard to imagine. If they do, will they also declare emergencies for diarrhoeal diseases?

Oxfam’s Takumo Yamada has similar concerns. He says, ‘Restricting the right to medicines would be completely contrary to the spirit of the Doha declaration. We urge developing countries not to waste their time discussing proposals that renege on previous commitments. The deadline for a solution to this problem already passed weeks ago and the blame for the continued deadlock lies squarely with rich countries.’

But the problem of access to medicines could be just the tip of the iceberg. In and interview in the Guardian newspaper in February, the United Kingdom’s chancellor of the exchequer Gordon Brown called on pharma companies to recognize that they have a responsibility to help the millions of people dying of diseases in the poorest countries. He agreed with US secretary of state Colin Powell that AIDS is, like terrorism, a threat to global security, saying, ‘Any world in which you have poverty, ill health and disease that is avoidable, side by side with what people can see as comfort and plenty, cannot be just or stable. Failure to act in these areas offends now only basic values, the dignity of individuals, and their right to a decent life, but it also affects national interests.

The next meeting of trade ministers is scheduled to take place in Cancun, Mexico in September. But the united States shows no inclination to remove its veto, and it seems unlikely that an agreement acceptable to both rich and poor nations will be reached by then. The problem of medications for the world’s poor could derail the Doha talks altogether.